Learning About Aphasia

Over the weekend, the family of actor Bruce Willis released a statement that he was retiring from acting due to a recent diagnosis of aphasia, a neurological disorder that impacts language and speech. This raised the question, just what is this disorder?

Actor Bruce Willis sparked the conversation

"Here at Connelly Law, we have worked with many clients who received a diagnosis of aphasia and were concerned that they needed to immediately take the steps that those with Alzheimer's disease do before they are unable to make decisions for themselves," said certified elder law Attorney RJ Connelly III. "What we have learned, however, is that although dementia does affect cognition, aphasia in itself doesn't do this. It appears that many people with aphasia maintain the full capacity to make decisions for themselves, however, their ability to communicate those decisions to others is the real challenge of this condition."

According to the National Aphasia Association, this acquired disorder of communication affects two million Americans with nearly 180,000 diagnosed annually with this condition. Stroke is the most common cause of aphasia in older adults, and anywhere from 25% to 40% of stroke survivors develop the disorder.

Colleen's Story of Aphasia

Colleen and her husband arrived at our office in the spring of 2019 and wanted to develop an estate plan. She had worked in the medical field prior to her diagnosis of aphasia. Her husband explained that it started a few years ago when she began to experience frequent headaches that progressively became increasingly serious and was initially diagnosed as a migraine condition.

"One morning, she woke up with a headache she described as feeling like her brain had exploded," said her husband. "She had trouble walking, dealing with noise, and vomited repeatedly. She laid on the bed and went to sleep and I went to the store to get her some fresh soup." But when he returned home, "it was like a different person sitting in front of me."

"One morning she woke up with a headache she described as feeling like her brain had exploded...she had trouble walking, dealing with noise and vomited repeatedly."

He stated that her sentences made no sense and when he asked her name, she would answer in some sort of "gibberish." She was rushed to the hospital where she was diagnosed with a stroke that was caused by a hole in her heart. "The cardiologists did what they needed to do to repair her heart, which went fine, but the neurologists told me that they feared massive deficiencies. It was scary."

Colleen communicates that she remembered little of what happened that day but remembered when she received the diagnosis of aphasia. "She was devastated," said her husband. "She was really depressed, unable to communicate, unable to tell the difference between an apple and a strawberry, she honestly felt that the person who she once was no longer existed and therefore, she did not exist. It was a tough time for her and the entire family."

The couple reported that attending support groups together and being educated in aphasia made things much better. "Coming in for an estate plan means that we see there is a future for her as a person and we as a couple. Life can and will go on."

Tackling Aphasia

Aphasia is a condition that affects the way a person communicates with the outside world. The condition can affect your speech, and the way you write and understand spoken and written words. Most of the time, aphasia occurs following a stroke or a head injury, but it can also be progressive due to a neurological disease or a slow-growing brain tumor. Aphasia can also be mild or severe, dependent upon the condition and the cause and amount of damage done to the brain.

Can you please repeat that?

"Once the cause for aphasia is identified and addressed, the main treatment at that point is speech and language therapy," said Attorney Connelly. "This means that the person with this condition must re-learn language skills or learn new ways to communicate."

People with aphasia may present with the following symptoms or actions:

  • Speak in short, cut-off sentences that may make no sense.

  • Substitute one word for another or one sound for another.

  • Write sentences or thoughts that make no sense.

  • Not being able to understand another person's conversation with them.

  • Speak words that may seem like another language.

And there is more than one type of aphasia.

Types of Aphasia

According to the Regional Neurological Associates website, there are six types of this condition:

  1. Global Aphasia - Global aphasia is the most severe type of aphasia. It is caused by injuries to multiple parts of the brain that are responsible for processing language. Patients with global aphasia can only produce a few recognizable words. They can understand very little or no spoken language. However, they may have fully preserved cognitive and intellectual abilities that are not related to language or speech. Global aphasia may be apparent immediately following a stroke or brain trauma. While this type of aphasia can improve as the brain heals, there may be lasting damage.

  2. Broca’s Aphasia - Broca’s aphasia is also called non-fluent or expressive aphasia. Patients with Broca’s aphasia have partial loss of their language ability. They have difficulty speaking fluently and their speech may be limited to a few words at a time. Because they can only get a few words out at a time, their speech is described as halting or effortful. They are usually able to understand speech well and maintain the ability to read but may have limited writing abilities.

  3. Mixed Non-Fluent Aphasia - Patients with this type of aphasia have limited and effortful speech, similar to patients with Broca’s aphasia. However, their comprehension abilities are more limited than patients with Broca’s aphasia. They may be able to read and write, but not beyond an elementary school level.

  4. Wernicke’s Aphasia - Wernicke’s aphasia is also called fluent aphasia or receptive aphasia. It is referred to as fluent because while these individuals have an impaired ability to comprehend spoken words, they do not have difficulty producing connected speech. However, what they say may not make a lot of sense and they’ll use nonsense or irrelevant words in their sentences. Often, they do not realize that they are using the incorrect words. Someone with Wernicke’s aphasia will probably have an impaired ability to read and write and lose much of their language comprehension ability.

  5. Anomic Aphasia - A person who suffers from anomic aphasia is unable to come up with the right words for what they want to talk about. They have a grasp on grammar and speech output, but they simply cannot find the words to discuss what they want to. When they speak, it is often vague and they might seem like they are “talking around” the thing they can’t describe. They also have difficulty finding words when they write.

  6. Primary Progressive Aphasia (PPA) - PPA is a neurological syndrome in which someone loses their ability to use language slowly and progressively. While most other forms of aphasia are caused by stroke, PPA is caused by neurodegenerative diseases like Alzheimer’s Disease. PPA progresses as the tissue in the language centers of the brain deteriorates over time. Because this form of aphasia is associated with degenerative disorders, PPA is eventually accompanied by other symptoms of dementia or memory loss.

When To See a Doctor

Aphasia may often appear suddenly and in such cases, may indicate an urgent medical condition such as a stroke. Those who experience the following need to seek emergency medical care immediately:

  • Difficulty speaking

  • Trouble understanding speech

  • Difficulty with word recall

  • Problems with reading or writing

If this is caused by a stroke, the earlier treatment is received, the less damage is done to the brain.

Many Causes of Aphasia

The Mayo Clinic website reports that the most common cause of aphasia is brain damage resulting from a stroke — the blockage or rupture of a blood vessel in the brain. Loss of blood to the brain leads to brain cell death or damage in areas that control language. Brain damage caused by a severe head injury, a tumor, an infection, or a degenerative process can also cause aphasia. In these cases, aphasia usually occurs with other types of cognitive problems, such as memory problems or confusion.

Sometimes temporary episodes of aphasia can occur. These can be due to migraines, seizures, or a transient ischemic attack (TIA). A TIA occurs when blood flow is temporarily blocked to an area of the brain. People who've had a TIA are at an increased risk of having a stroke at some point in the near future, according to the site.

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